What is the appropriate approach to manage a patient with triple-negative, locally advanced breast cancer (LN+) who progresses on neoadjuvant chemo-immunotherapy (KEYNOTE-522 regimen)?

Given the aggressiveness of the KEYNOTE-522 regimen, second-line chemo seems unlikely to be effective. Assuming the patient is currently not resectable, recommend breast RT concurrently with a well-tolerated radiosensitizer, e.g., capecitabine, dose, and fractionation depending on the presence or ab...

Unfortunate situation.

Options would be second-line chemo and then surgery or if operable now to do surgery followed by adjuvant chemo and RT.

I have seen this a few times. We often consider second-line treatment. If, after that, they are resectable, we go to surgery. If they aren't resectable or borderline, we do consider neoadjuvant chemoradiation with capecitabine.